Knowledge, beliefs and experience of adopting healthy habits in pregnancy: a mixed methods study

Abstract Background Early life exposures affect a child's obesity risk. The EARLY START uses participatory action research to develop an intervention for reducing early life obesogenic exposures. The initial phase uses a mixed methods approach to investigate pregnant mothers’ knowledge, beliefs, and experience of adopting healthy dietary and physical activity (PA) habits. Methods Cypriot pregnant women in 2021 completed a web-based questionnaire on: a) Adherence to Mediterranean diet (MD) (MEDAS tool); b) knowledge, beliefs on diet and PA. A subgroup participated in a structured focus group discussion of their experience/needs in adopting healthy habits. Data were analyzed using Descriptive and Thematic Content methods. Results Ninety-seven women participated, 73% <35 y.o., 49% primigravida, 92% with tertiary education. Adherence to MD was moderate (median 6/14, IQR 2.5), 90% were eating <3 portions of fruit/vegetables daily, 50% believed their diet was healthy and did not change habits in pregnancy. Most had access to information (94%), internet was the commonest source (74%), and the doctor the most trusted (47%). Mild and moderate-intensity PA were considered appropriate by many (60%) for the first and second half of pregnancy, respectively. Most (90%) were aware of the risks of excessive weight gain in pregnancy. Qualitative analysis showed that women value diet as “the main driver to holistically achieving a healthy pregnancy”. The main barrier was the “struggle between the will and ability”. PA was considered a “therapy” but the challenge was “to achieve the right balance”. Internet was described as “accessible but unreliable information source”. Women believed that needs can be met by “early, holistic recommendation-based interventions run by professionals”. Conclusions A huge gap exists between knowledge, beliefs, and practice of healthy behaviours in pregnancy. New interventions should meet gaps and needs using contextualized, timely, holistic, and reliable approaches. Key messages Exploring knowledge and experience of healthy habits in pregnancy as part of participatory action research in shaping an obesity prevention intervention revealed important gaps and unmet needs. Future interventions should holistically address knowledge gaps and behavioral change needs using contextualized, timely, holistic and reliable information and methods.


Background:
Pregnancy is a risk condition for hospitalization and severe illness from Covid-19, with an increased risk of maternal mortality and serious neonatal complications. The study examines Italian pregnant women's attitudes about the Covid-19 vaccine, the role of healthcare professionals' (HP) communication, the reasons and potential predictors for nonadherence to vaccination. Methods: An online survey was developed by LimeSurvey software and spread through social media between August 2021 and January 2022 to pregnant women of age living in Italy. Participants were asked to indicate their sources of information and to rate the support received from their HP; their health literacy (HL) was assessed using the HLS-EU-Q6 tool. Multivariate linear regression analysis was performed. Open-ended questions were analysed using MaxQDA 2022. Results: 1594 total survey responses were obtained (median age 31.5AE4.94); 48% of the participants had a university degree. Only 17% of women had sufficient HL. Most (52%) of them refused to be vaccinated against Covid-19 while pregnant, 27% were unsure and 26% disagreed about the safety of the vaccine during pregnancy. Most of them did not deem the information received by HP complete (56%), clear (52%), and reliable (46%); 49% of them did not feel supported in their decision to vaccinate. This variable was the main predictor of vaccine hesitancy in addition to concern about vaccine safety in the multivariate model. Among women who felt unsatisfied 57% had an inadequate HL compared to 40% of those who had sufficient HL (p<.0001). The analysis of the open-ended questions also revealed a pervasive feeling of uncertainty.

Conclusions:
The study highlights how the lack of adequate communication and support by HP had a strong impact in the adherence to Covid-19 vaccination among pregnant women. Key messages: The lack of an effective communication by healthcare professionals contributed to the feeling of uncertainty and concern of pregnant women about Covid-19 vaccination.
There is a need to put effort on training for HP to improve their communication skills to support pregnant women's health decisions and improve their literacy in such a delicate phase of their life.

Background:
Early life exposures affect a child's obesity risk. The EARLY START uses participatory action research to develop an intervention for reducing early life obesogenic exposures. The initial phase uses a mixed methods approach to investigate pregnant mothers' knowledge, beliefs, and experience of adopting healthy dietary and physical activity (PA) habits.

Methods:
Cypriot pregnant women in 2021 completed a web-based questionnaire on: a) Adherence to Mediterranean diet (MD) (MEDAS tool); b) knowledge, beliefs on diet and PA. A subgroup participated in a structured focus group discussion of their experience/needs in adopting healthy habits. Data were analyzed using Descriptive and Thematic Content methods.

Results:
Ninety-seven women participated, 73% <35 y.o., 49% primigravida, 92% with tertiary education. Adherence to MD was moderate (median 6/14, IQR 2.5), 90% were eating <3 portions of fruit/vegetables daily, 50% believed their diet was healthy and did not change habits in pregnancy. Most had access to information (94%), internet was the commonest source (74%), and the doctor the most trusted (47%). Mild and moderate-intensity PA were considered appropriate by many (60%) for the first and second half of pregnancy, respectively. Most (90%) were aware of the risks of excessive weight gain in pregnancy. Qualitative analysis showed that women value diet as ''the main driver to holistically achieving a healthy pregnancy''. The main barrier was the ''struggle between the will and ability''. PA was considered a ''therapy'' but the challenge was ''to achieve the right balance''. Internet was described as ''accessible but unreliable information source''. Women believed that needs can be met by ''early, holistic recommendation-based interventions run by professionals''.

Background:
Despite well-recognised benefits, Irish breastfeeding rates remain suboptimal. Although associations between breastfeeding and allergic disease are well-researched in younger children, evidence for continued effect in older children is sparse. This Irish prospective cohort study investigated associations between breastfeeding and allergic disease at age nine.

Methods:
The study sample included all nine-year-old children enrolled in the Growing Up in Ireland Infant Cohort Study whose mothers had participated in both Wave 1 and Wave 5. Mothers self-reported infant feeding practices at nine months and allergic diseases at nine years. Multiple logistic regression was used to generate adjusted odds ratios (aOR) for associations between breastfeeding and allergic diseases; re-weighting was applied to enhance generalisability.

Conclusions:
This study provides new evidence suggesting breastfeeding may be protective against asthma and eczema but may increase the risk of atopic rhinitis in older Irish children. Results must be considered in light of high Irish allergic disease prevalence and action in support of breastfeeding prior to and following birth prioritised accordingly.

Key messages:
Findings lend support to a protective association between breastfeeding and asthma and eczema in later childhood and indicate breastfeeding may play a role in allergic disease prevention.
Breastfeeding may reduce the risk of asthma and eczema in Irish children: findings should be used to drive impactful breastfeeding promotion and reorientate cultural norms in favour of breastfeeding.

Background:
The implementation of a health service does not necessarily equate to a health gain. Effective Coverage (EC) aims to capture the potential benefits of a health intervention by adjusting the crude coverage for quality. The aim of this study was to assess the EC of Antenatal Care (ANC), Institutional deliveries and Postnatal Care (PNC) in Oyam district, Uganda, considering the input (drugs and equipment) and the process dimension (components of care provided).

Methods:
The study involved 19 Health Centers (HC), 12 type II, 6 type III and 1 type IV, having a catchment area of 15.603 expected deliveries per year. The analysis covered the period between April and September 2021. Data on crude coverage were retrieved from the District Health Information Software-2. Data used to assess quality domains were extracted from checklists compiled during Supportive Supervisions and were summarized by readiness and likelihood of quality care indices. The crude coverage of the interventions was adjusted to calculate the input-adjusted and the quality-adjusted coverage.

Results:
The readiness index was 0.81 for ANC, 0.82 for institutional delivery and 0.88 for PNC, while the likelihood of quality of care was 0.73, 0.88 and 0.89 respectively. In all three areas, the loss of coverage was mainly due to lack of materials and equipment; HCs II showed lower quality indexes than HCs III, particularly for ANC (P = 0.007). Compared to the target population, EC was 40% for ANC4 visits, 48% for institutional deliveries and 77% for PNC visits. The gap between crude and EC was higher for ANC4 (-30%) compared with the one for institutional deliveries (-18%) and PNC (-23%).

Conclusions:
EC is a useful indicator for monitoring maternal and neonatal services in low-resource countries, bringing gaps in crude coverage to the surface. Supportive Supervision provides an opportunity to assess EC at the facility level without additional resources and to support health authorities in setting priorities. Key messages: The application of EC framework can be adapted both at district and facility level, either to a single service or healthcare pathways, and guide public health intervention. Integration of Supportive Supervision data in the EC is an innovative approach and permit to include the quality of care dimension in the routine data collection. Background: Ultrasound (US) can help monitor normal fetal development and screen for any potential problems. The prenatal detection of fetal anomalies allows for optimal perinatal management. Aim: The aim was to assess congenital anomalies at births and their associated antenatal care factors.